malnutrition in disease and ageing Flashcards
principles nutrition screening, diagnosics, dinstinguish different nutrition disorders
What is malnutrition?
A state resulting from lack of uptake or intake nutrition leading to altered body composition, leading to diminished physical and mental function and impaired clinical outcome from disease
Name three causes of malnutrition
Reduced food intake
impaired digestion
altered nutrient metabolism and excretion
How does reduced food intake occur in relation to symptoms to illness?
Anorexia can be due to symptoms of an ilness: nausea, vomiting, pain with eating, difficulty chewing or swallowing, depression or psychological
How does reduced food intake occur in relation to treatments?
side effects of medication, preperation to surgery of diagnostic tests, surgical resection of head, neck, mouth or esophagus.
What are the two wats to diagnose malnutrition
1: Having a BMI >18,5 kg/m2
2: Unintentional weightloss of 10% over indefinite amount of time. Or having 5>% weightloss over the last three months
In combination with BMI <20 kg/m2 if <70 years of age.
What is the prevalence of malnutrition in outpatiets
In oral macillofacial surgery 17% has severe undernutrition
Followed by oncology where 10% has severe undernutrition.
Where can we find the most malnourished people?
In the hospital and specifically in the geriartrics departments
What population in the community has the highest rate of undernutrition?
Home care: community-dwelling elderly with home care
What are the reasons for poor recognition by health care provider of malnutrition in community’s
There are limited screening by GP’s, there is no time, no training, no priority, nutrition is only a small part of medical curricula
What are the reasons adults have poor malnutrition awareness
people think malnutrition only occurs in poor countries and at times of water. Also losing weight is normal aspect of aging. Weightloss is often appreciated.
When do you speak of acute diseased related malnutrition?
When there is highly pronounced stress metabolism. Patients in ICU, Trauma, sepsis or after major surgical procedures are at high risk.
CRP >50 mg/l
increased corticosteroid or catecholamine release
resistance to insulin and growth hormones
no/reduced foot intake
Chronic disease related malnutrition is
When do we speak of chronic disease related malnutrition with inflammation?
Seen in late stage organ diseases that are complicated by catabolic inflammatory responses: cancer, cachexia, Chron’s disease, COPD, chronic kidney disease
It is featured by:
weightloss
reduced BMI
reduced muscle mass and function
Combined with underlying disease that displays biochemical indices of ongoing inflammatory activities (CRP>5 mg/l)
How can CACHEXIA be defined?
It is a multifactorial syndrome characterized by an ongoing loss of skeletal muscle mass that cannot be reversed by convential nutritional support. It leads to progessive functional impairment
What mechanisms can cause disease related malnutrition without inflammation?
It is featured by:
Weight loss
low BMI
reduced muscle mass and function
combined with underlying disease
Is seen in:
dysphagoa, malabsorption, neurologic disorders (Parkinsons, ALS, stroke)
dementia/ cognitive dysfunction
psychiatric conditions like anorexia nervosa and depression
